Background: Pulmonary embolism (PE) and atrial fibrillation (AF) may coexist. The association and impact of AF on PE have not been well studied.
Methods: We queried the 2018 National Inpatient Sample (NIS) database to identify PE and AF hospitalizations using appropriate ICD-10 codes. PE with AF group was compared to PE without AF. Chi-square test and linear regression were used for categorical and continuous variables, respectively. Multivariate logistic regression was used to adjust for potential hospital and patient confounders (age, sex, race, diabetes, systolic heart failure, chronic kidney disease, obesity, Charlson co-morbidity index, hospital location, teaching status, bed size and income status). Discharge weights provided in the database was used to calculate the national estimates. STATA 16.1 was used to perform all statistical analysis.
Results: 189,314 weighted PE hospitalizations were identified. Of which, 23,444 (12%) of them had atrial fibrillation. PE patients with AF were older (73 vs 61 yrs), more often male (52% vs 47%), less often obese (23% vs 76%) and had CKD (20% vs 79%). We observed statistically significant increase in mortality [Odds Ratio (OR): 1.4 (1.2-1.7); P = <0.01], length of stay [5.6 vs 4.1 days; P = <0.01], total hospitalization charges [$62,655 vs $47,874; P = <0.01], right heart failure [OR: 1.4 (1.1-1.8); P = <0.01], cardiogenic shock [OR: 2.0 (1.6-2.6); P < 0.01] in PE patients with AF when compared to those without AF after adjusting for potential patient and hospital level confounders.
Conclusions: Presence of AF is an independent predictor of mortality, length of stay, hospitalization charges, right heart failure and cardiogenic shock in patients with PE. This study helps to assume prognosis and raise awareness of the intensity of care toward these patients. More research is required in PE with AF pathophysiology and to decrease the morbidity and mortality in this specific group.